Sprint kinematics of athletes with lower-limb amputations.

OBJECTIVE: To determine and compare the kinematics of the sound and prosthetic limb in five of the world's best unilateral amputee sprinters. SUBJECTS: Five men, all unilateral lower-limb amputee (one transfemoral, four transtibial) athletes. The individual with transfemoral amputation used a Endolite Hi-activity prosthesis incorporating a CaTech hydraulic swing and stance control unit, a Flex-Foot Modular III, and an ischial containment total contact socket. Those with transtibial amputations used prostheses incorporating a Flex-Foot Modular III and patellar tendon-bearing socket, with silicone sheath liner (Iceross) and lanyard suspension. DESIGN: Case series. Subjects were videotaped sprinting through a performance area. Sagittal plane lower-limb kinematics derived from manual digitization (at 50 Hz) of the video were determined for three sprint trials of the prosthetic and sound limb. Hip, knee, and ankle kinematics of each subject's sound and prosthetic limb were compared to highlight kinematic alterations resulting from the use of individual prostheses. Comparisons were also made with mean data from five able-bodied men who had similar sprinting ability. RESULTS: Sound limb hip and knee kinematics in all subjects with amputation were comparable to those in able-bodied subjects. The prosthetic knee of the transfemoral amputee athlete fully extended early in swing and remained so through stance. In the transtibial amputee athletes, as in able-bodied subjects, a pattern of stance flexion-extension was evident for both limbs. During stance, prosthetic ankle angles of the transtibial amputee subjects were similar to those of the sound side and those of able-bodied subjects. CONCLUSION: Prosthetic limb kinematics in transtibial amputee subjects were similar to those for the sound limb, and individuals achieved an "up-on-the-toes" gait typical of able-bodied sprinting. Kinematics for the prosthetic limb of the transfemoral amputee subject were more typical of those seen for walking. This resulted in a sprinting gait with large kinematic asymmetries between contralateral limbs.     

Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations

OBJECTIVES: To examine 12-month reamputation and mortality rates as well as acute and postacute medical care costs among a large cohort of persons with dysvascular amputations. DESIGN: Retrospective cohort study. SETTING: General community. PARTICIPANTS: Medicare beneficiaries identified from the Centers for Medicare and Medicaid Services data as undergoing a lower-limb amputation secondary to vascular disease in 1996. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Twelve-month reamputation and mortality rates, and acute and postacute medical care costs, by initial amputation level and presence or absence of diabetes. RESULTS: A total of 3565 persons, corresponding to 71,300 Medicare beneficiaries nationwide, were identified from the claims data as undergoing lower-limb amputations in 1996. Twenty-six percent of them required subsequent amputation procedures within 12 months, and more than one third died within 1 year of their index amputation. Acute and postacute medical care costs associated with caring for beneficiaries with a dysvascular amputation exceeded $4.3 billion yearly. There were marked differences in patient characteristics, progression of amputation to higher levels, service use, and mortality among dysvascular amputees with and without a comorbidity of diabetes. Diabetic amputees were younger than those without diabetes; they were also more likely to be men, to have more comorbidities, and to have undergone their first amputation at an earlier age than persons with dysvascular amputations who did not have diabetes. Although diabetic amputees were less likely to die within 12 months of the index amputation, they died at a significantly younger age than their nondiabetic counterparts. Progression to a higher level of limb loss occurred most frequently (34.5%) among persons with an initial foot or ankle amputation. Diabetic amputees were more likely than nondiabetic amputees to experience progression to a higher amputation level for all initial amputation levels. CONCLUSIONS: This study provides information that can be used by physicians when counseling patients about expected outcomes of dysvascular amputations at different levels.     

Seizures in patients with multiple sclerosis seen at Mayo Clinic, Rochester, Minn, 1990-1998

OBJECTIVE: To evaluate seizure type, electroencephalographic findings, and response to antiepileptic drug (AED) treatment in patients with multiple sclerosis (MS) and coexistent seizure activity. PATIENTS AND METHODS: We reviewed the medical records of all patients seen at the Mayo Clinic in Rochester, Minn, with the diagnosis of MS and seizures between 1990 and 1998. RESULTS: During the study period, 5715 patients with MS were identified. Of these 5715 patients, 51 (0.89%) experienced seizure activity. The most common ictal behavior was a generalized tonic-clonic seizure in 35 patients (68.6%). Simple or complex partial seizures occurred in 11 patients (21.6%), and 18 patients (35.3%) had only 1 seizure episode. Focal motor status epilepticus, ie, epilepsia partialis continua, occurred in 3 patients (5.9%) and was associated with cognitive impairment. In 37 patients (72.5%), the initial seizure presentation was after the diagnosis of MS. A seizure resulted in the diagnosis of MS or occurred before the diagnosis of MS but after other symptoms or signs of demyelinating disease in 14 patients (27.4%). Electroencephalography was performed in 43 patients. Electroencephalographic findings included diffuse or localized nonspecific background slowing in 19 patients (44.2%), unilateral or bilateral frontotemporal spike discharges in 9 (20.9%), generalized atypical spike-and-wave or multifocal independent epileptiform alterations in 6 (14.0%), and normal results in 11 (25.6%). Of the 45 patients who received AED therapy, 35 (77.8%) had an excellent response, ie, they were seizure free. Five treated patients (11.1%) had an intractable seizure disorder. CONCLUSION: Most of the patients with MS who experienced seizure activity had a benign and transient disorder that was responsive to AED treatment or required no therapy.     

Diabetes trends in the U.S.: 1990-1998

OBJECTIVE: To examine trends in diabetes prevalence in the U.S. RESEARCH DESIGN AND METHODS: This study was conducted via telephone surveys in states that participated in the Behavioral Risk Factor Surveillance System between 1990 and 1998. The participants consisted of noninstitutionalized adults aged 18 years or older. The main outcome measure was self-reported diabetes. RESULTS: The prevalence of diabetes rose from 4.9% in 1990 to 6.5% in 1998--an increase of 33%. Increases were observed in both sexes, all ages, all ethnic groups, all education levels, and nearly all states. Changes in prevalence varied by state. The prevalence of diabetes was highly correlated with the prevalence of obesity (r = 0.64, P<0.001). CONCLUSIONS: The prevalence of diabetes continues to increase rapidly in the U.S. Because the prevalence of obesity is also rising, diabetes will become even more common. Major efforts are needed to alter these trends.     

Prostheses for persons with lower-limb amputations: an extra joint increases range of motion.

This report describes two cases in which the addition of an extra joint enhanced range of motion and improved function in persons with unilateral lower-limb amputation. Both individuals had significant disability in the workplace and at home before this modification. In the first case, an individual with a hemipelvectomy had inadequate hip-joint flexion for maneuvering during photo shoots. In the second case, the individual's transfemoral prosthesis provided insufficient knee flexion for kneeling and working in tight spaces. In each case, a manual-locking, single-axis knee joint was added adjacent to the joint with the limited range of motion. In both cases, the addition of the second joint provided the increased flexibility needed. The first person's hip-flexion range improved from 125 degrees to 190 degrees, and the second person's knee-flexion range improved from 140 degrees to 170 degrees. In repeated follow-up, both patients remained highly satisfied with the intervention. The addition of an extra joint is an option that should be considered when inadequate range interferes with function.     

莱芜市1998-2002年肺结核疫情流行病学分析

目的　探讨莱芜市 1998- 2002年肺结核疫情动态 ,控制肺结核传播蔓延。方法　采用流行病学回顾性调查 ,对莱芜市 5年来肺结核报告病例的人群、地区、时间分布进行流行病学分析。结果　 1998-2002年全市共新登记活动性肺结核 1 637例 ,涂阳病人 6 87例 ,其中新发涂阳 5 6 3例 ,复发涂阳 12 4例。年均活动性肺结核新登记率为 26.58/10万 ,菌阳新登记率为 11.15/10万 ,新发涂阳新登记率为 9.14/10万。 16 37例活动性肺结核患者中 ,男性患病率明显高于女性 (P <0.0 1) ,80.46%的病例集中在 15 - 64岁的中青年组 ,87.48%的患者是农民 ,农民患病率明显高于其他职业人群 (P <0.01) ,乡镇活动性肺结核新登记率及涂阳病人新登记率明显高于城区(P<0.01)。结论　男性患者 ,15 - 64岁中青年患者及农民患者是实施和执行现代肺结核控制策略的重点。     

Rasch analyses of the Activities-specific Balance Confidence Scale with individuals 50 years and older with lower-limb amputations

Sakakibara BM, Miller WC, Backman CL. Rasch analyses of the Activities-specific Balance Confidence Scale with individuals 50 years and older with lower-limb amputations.

Objectives

To explore shortened response formats for use with the Activities-specific Balance Confidence (ABC) Scale and then evalute the unidimensionality of the scale, the item difficulty, the scale for redundancy and content gaps, and the item standard error of measurement (SEM) and internal consistency reliability among aging individuals with a lower-limb amputation living in the community.

Design

Secondary analysis of cross-sectional survey and chart review data.

Setting

Outpatient amputee clinics, Ontario, Canada.

Participants

Community living adults (N=448; ≥50y; mean, 68y) who have used a prosthesis for at least 6 months for a major unilateral lower-limb amputation. Of the participants, 325 (72.5%) were men.

Interventions

Not applicable.

Main Outcome Measure

ABC Scale.

Results

A 5-option response format outperformed 4- and 6-option formats. Factor analyses confirmed a unidimensional scale. The distance between response options is not the same for all items on the scale, evident by the Rasch Partial Credit Model (PCM) having a better fit to the data than the Rasch Rating Scale Model. Two items, however, did not fit the PCM within statistical reason. Revising the wording of the 2 items may resolve the misfit and improve the construct validity and lower the standard error of measurement. Overall, the difficulty of the scale's items is appropriate for use with aging individuals with lower-limb amputation, and is most reliable (Cronbach α=0.94) for use with individuals with moderately low balance confidence levels.

Conclusions

The ABC Scale with a simplified 5-option response format is a valid and reliable measure of balance confidence for use with individuals aging with a lower-limb amputation.     

Substantial increase in incidence of severe hypoglycemia between 1997-2000 and 2007-2010: a German longitudinal population-based study

OBJECTIVE

To compare the incidences of severe hypoglycemia and corresponding clinical circumstances in a German population between 2007–2010 and 1997–2000.

RESEARCH DESIGN AND METHODS

A screening for severe hypoglycemia was performed in the Lippe-Detmold area in Germany to sensitively detect severe hypoglycemia. This was defined as a symptomatic event requiring treatment with intravenous glucose and being confirmed by a blood glucose measurement of <50 mg/dL.

RESULTS

Severe hypoglycemia increased considerably from 264 events in 1997–2000 to 495 events in 2007–2010, which translated into an increase in frequency of severe hypoglycemia among all emergency admissions from 0.68 to 0.83% (P = 0.015). This was mostly related to intensification of antihyperglycemic therapy, particularly in the increasingly morbid group of hypoglycemic patients with type 2 diabetes indicated by lower HbA_1c, more comedication (3.3 vs. 7.7 drugs), and more concomitant diseases (3.6 vs. 4.4) (all P values <0.001).

CONCLUSIONS

Within a 10-year period, there was an intensification of antihyperglycemic therapy in increasingly comorbid subjects, leading to a considerably higher incidence of severe hypoglycemia.Severe hypoglycemia remains the limiting factor in successful metabolic control of diabetes mellitus. In patients with long-standing and complicated diabetes mellitus, severe hypoglycemia may even increase cardiovascular and all-cause mortality (1). In the current study, we compared the incidence rates of severe hypoglycemia and corresponding clinical circumstances between the years 2007–2010 and 1997–2000 in a German population.     

Questionnaire on the satisfaction of persons with lower-limb amputations towards their prosthesis: development and validation]

The satisfaction of persons with lower-limb amputations towards their prosthesis constitutes a critical factor in the use of the prosthesis. In order to evaluate a person's satisfaction, the SAT-PRO, a self-administrated questionnaire was developed. The questionnaire includes 15 items developed on the basis of the most significant criteria used by the person when selecting a technical aid. These criteria were measured using an ordinal categorical four-level scale. The validation of the SAT-PRO was established from a sample consisting of 61 people with below-knee or above-knee amputations, aging from 60 years and older. The internal consistency of the instrument is high (Cronback's alpha coefficient is 0.90) and the test-retest reliability coefficient (0.97) indicates a very good consistency of the questionnaire over time. Simple and multiple correlations were used to evaluate construct validity. The degree of use of the prosthesis and the feelings of depression, amongst the measured variables, are the best indicators of the satisfaction of the amputees toward their prosthesis.     

秦皇岛市1998-2000年AFP病例监测分析

秦皇岛市自建立脊髓灰质炎疫情专报系统以来 ,急性弛缓性麻痹 (简称ＡＦＰ)病例监测工作不断完善 ,全市总人口 2 5 8 75万 ,1 5岁以下儿童 47 5 5万。 1 998- 2 0 0 0年全市脊髓灰质炎监测系统共报告 36例ＡＦＰ病例 ,1 5岁以下儿童报告年发病率分别为 2 92 /1 0万、2 1 0 /1 0万和 2 5 2 /1 0万。达到了消灭脊髓灰质炎工作的要求。 36例ＡＦＰ病例均采集粪便标本 ,标本采集率为 1 0 0 % ;双份合格大便标本 34份 ,合格率为 94 44%。ＡＦＰ监测系统指标已达到ＷＨＯ和卫生部规定要求。现将我市 1 998- 2 0 0 0年ＡＦＰ监测工作情况分析如…     

宁波市1990-1999年病毒性肝炎流行特征分析

随着儿童计划免疫工作和甲、乙类传染病 (简称传染病 )监测控制措施的不断落实 ,使各种传染病的发病率、死亡率及病谱的构成发生很大的变化。本文对宁波市 1 990 - 1 999年病毒性肝炎的流行特征进行了系统的分析 ,为更好地制定病毒性肝炎控制策略提供依据。结果报告如下。资料来源与方法病毒性肝炎资料来源于宁波市 1 1个县 (市 )区法定传染病的历年年报 ;人口资料由市统计局和市公安局提供。所有资料均输入计算机 ,建立统一数据库 ,用ＳＰＳＳ统计软件包进行统计分析。另外 ,在本研究中 ,把宁波市的海曙区、江东区、江北区、镇海区和北仑区…     

驻马店市1998-2001年疑似梅毒感染情况调查分析

梅毒(syphilis,lues)是性传播疾病中的最常见病。近年来性传播疾病的广泛流行,虽然有其错综复杂的原因,现已成为全球性的公共卫生问题和社会问题。从我们近几年的检测中发现梅毒的发病率在我市有明显上升趋势。本文对我市不同年龄和不同职业的人群12800人梅毒感染情况进行了调查。现将我市1998-2001年的调查情况分析报     

潮阳市1990-2002年病毒性肝炎流行趋势分析

病毒性肝炎是我国严重影响人民身体健康的重点防治的法定传染病 ,近 1 3年来随着诊断技术的逐步提高 ,病毒性肝炎已成为全市法定报告传染病的主要病种。为全面了解病毒性肝炎的发病情况及其流行规律 ,为制订防治措施提供理论依据 ,现将潮阳市 1 990 - 2 0 0 2年病毒性肝炎流行状况分析如下。材料与方法资料来源于潮阳市 1 990 - 2 0 0 2年法定报告传染病统计年报表、疫情汇编材料。以常住本地人口的病例列入统计。人口资料以市统计局公布为准。运用描述流行病学研究方法进行分析。结　　果1 流行趋势 :1 990 - 2 0 0 2年潮阳市共报告病毒性…